* Part of family cluster
** Healthcare worker and part of outbreak linked to hospital
*** Patient transferred to UK
**** Patient transferred to Germany
NK: not known

The above comment and list of
novel beta coronavirus confirmed cases are from the latest ECDC
update. The prior
report claimed that human transmission was unlikely because of an
absence of confirmed mild cases, which somehow indicated that the
source of infection was animal or environmental. However, as seen
in the above list, 7 of the 11 confirmed cases were from the three
cited clusters (linkage to an ICU in Jordan, a familial cluster in
Saudi Arabia, or a familial cluster in the UK. Even prior to the
latest case, the two earlier clusters included 5 of the 10 confirmed
cases as well as a number of milder cases which WHO classified as
“probable” because of failures to confirm the presence of the novel
coronavirus.

However, above list has
glaring omissions with regard to disease onset dates, as well as the
linkage between the above confirmed cases and symptomatic milder cases,
which were not confirmed. These symptomatic contacts were cited
as probable cases by WHO indicating that the epidemiological data
suggested that there were milder cases which were not confirmed due to
testing limitations.

The largest group of probable
cases was in the Jordan
ICU cluster, which included the first two cases on the above
list. WHO has not been transparent on the age, gender, or disease
onset dates for these cases.. Since the ECDC has published “risk
assessments” they should have access to the IHR reports, which should
include disease onset dates.

The Jordan Ministry of Health initially denied that the death of
the second health care work (25M intern) was unrelated to the first
death (40F nurse), the second cases, but after these cases were
confirmed he acknowledged that the deaths were 7 days apart (April 19
and 26, respectively). The week gap in the dates of death
suggests the disease onset dates were similarly gapped, which is more
consistent with human to human transmission than a common environmental
source. Moreover, one of the symptomatic cases was the son of the
nurse and most of the symptomatic co-workers were hospitalized.
The failure to confirm any of the surviving cluster members suggests
that the assay’s ability to identify mild cases is suspect.

Similarly, WHO has withheld
disease onset dates for the familial
cluster in Riyadh (cases 7-9). However media reports
indicated the two fatal cases were father and son, with the father
being 70 years of age. Moreover, the dates of death were four
days apart, which also supports human to human transmission.
Similarly, WHO failed to confirm the presence of one of the symptomatic
family members, who was also classified as a probable case, raising
additional concerns for the lab testing.

Thus, the ECDC earlier
position had little support, and mild cases are likely widespread but
undetected due to a limited testing protocol, as well as heavily biased
testing which targets severe cases.

The latest cluster has a large
disease onset time gap in two well separate locations, providing the
most compelling data on human to human transmission.